This research will develop methodologies for assessing patient and staff adherence to cancer chemotherapy programs and for identifying factors contributing to compliance behavior. Specific aims are: a) to develop and apply techniques to dientify the frequency and extent of: 1. patient compliance with recommended diagnostic procedures, appointments, continued participation in protocols, staff administered (intravenous) and patient administered (oral) medications; 2. staff compliance with chemotherapy protocols. b) to determine what relationship patient, illness, treatment, or health care provider variables have on patient or staff compliance; c) to study the relationship between compliance factors and patient outcome in terms of morbidity and mortality. The specific aims will be accomplished by patient and staff interview techniques, physiologic assay, chart review methods, and rating scales of psychological and medical status. These will be applied in a longitudinal study of patient compliance with four differing chemotherapy protocols used for the treatment of Stage II and Stage IV breast cancer. The percentage of appointments and diagnostic procedures kept as well as the percentage of low and high toxicity medications taken as prescribed will be monitored over the course of a year's treatment. Differences between protocols over time will be evaluated and factors predictive of compliance will be assessed by multiple regression techniques. Associations between compliance and outcome will be evaluated. These findings have far reaching implications not only in cancer but in other illnesses as well. It permits the detection of staff and patients at risk for noncompliance and subsequent morbidity and mortality.